Provider Demographics
NPI:1720383458
Name:HOSPITAL GENERAL MENONITA AIBONITO
Entity Type:Organization
Organization Name:HOSPITAL GENERAL MENONITA AIBONITO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCADO MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:LND
Authorized Official - Phone:1787-735-8001
Mailing Address - Street 1:PO BOX 1184
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-1184
Mailing Address - Country:US
Mailing Address - Phone:178-731-8500
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL GENERAL MENONITA AIBONITO
Practice Address - Street 2:BO. CAONILLA
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-735-8001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1521261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health